PROJECT 1

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The rise in cancer incidence among younger adults (ages 20-39) in NYC is currently outpacing the increase across the rest of the US (96.9 vs. 89.5 per 100,000). However, the burden of cancer in NYC is not equally distributed. In NYC's poorest neighborhoods, the rates of preventable cancers, such as cervical cancer, is 73% higher compared to the wealthiest neighborhoods. The magnitude of this disparity exceeds those associated with Black race, Hispanic ethnicity, or residence in a rural county documented in a previous population-based study of the US. Rather, it is likely the persistent poverty in these neighborhoods that drives cancer disparities. Despite these known facts, there remains limited research on multi-level and multi-generational approaches that address the impact of persistent poverty on youth and young adults' current and future cancer risk behaviors. Effective cancer education interventions in schools could significantly impact health-promoting intentions and cancer risk behaviors in younger adults. To date, most school-based intervention studies have been limited. The need for this research is especially salient in NYC, the most populous city in the United States, with nearly 2 million New Yorkers under 18. In response to RFA-CA-22-015 Cancer Control Research in Persistent Poverty Areas, this application in randomize a total of 10 new York City schools (n=906 students) in two waves, over 2 years, to an immediate vs delayed (wait list control) six-week cancer education and social justice intervention delivered by trained classroom science teachers. The intervention is guided by the Self-Determination and youth empowerment theory, thus it will leverage the natural desire of youth to be socially conscious, autonomous individuals who can be effective agents of social change. The intervention aims to: 1) increase students’ intention to engage in at least one health-promoting behavior (e.g., drink less or no sugary beverages) in the next month as a predictor of actual behavior change; and 2) increase cancer risk communication between the student and a parent. Additionally, we will explore the impact of increased cancer risk communication on the health-promoting behaviors of at least one parent or adult caregiver in the household. Assessments of students will be conducted at baseline, 6 and 24 weeks. Parents will be assessed 6 weeks after implementation of the curricula and then again at 24 weeks. If effective, our pragmatic approach provides a framework for integrating a cancer education intervention with a social justice lens more broadly into NYC public schools, the largest public school system in the country. This program will have far-reaching effects, empowering adolescents with knowledge that can not only mitigate future cancer incidence of vulnerable youth but also promote healthier behaviors within families.